Semmler Carolin, Wunderle Veronika, Kuzu Taylan D, Onur Oezguer A, Grefkes Christian, Barbe Michael T, Fink Gereon R, Weiss Peter H
Faculty of Medicine, University of Cologne, Cologne, Germany.
Department of Neurology, University Hospital Cologne, Cologne, Germany.
Neurol Res Pract. 2025 Jun 16;7(1):41. doi: 10.1186/s42466-025-00394-z.
Idiopathic Normal Pressure Hydrocephalus (iNPH) is a potentially reversible cause of cognitive impairment, urinary incontinence, and gait disturbances, which typically present with a characteristic slow, shuffling, and wide-based gait. Gait velocity, which is reduced relative to healthy controls, improves in iNPH patients following a spinal tap test. This study aimed at evaluating the criterion of a 20% gait velocity improvement in the 10 m walk test to identify responders and non-responders in a cohort of patients with probable iNPH receiving a spinal tap test as well as the added value of instrument-supported gait analysis.
We assessed pace, rhythm, variability, postural control, and force in 59 patients with clinically suspected iNPH undergoing a spinal tap test, applying the 10 m walk test and an instrument-supported gait analysis. The change in gait velocity assessed in the 10 m walk test was used to differentiate patients with a positive response to the spinal tap (> 20% improvement, responders) from those with no relevant response (< 20% improvement, non-responders). Group differences were analyzed using chi-square tests, independent sample t-tests, Mann-Whitney-U tests and repeated measure ANOVAs.
Unlike non-responders (n = 39), responders (n = 20) showed significant changes in the gait domain pace in the 10 m walk test. Moreover, instrument-supported gait analyses revealed additional improvements in the gait domains variability, rhythm, postural control and force in responders only.
This study confirmed the clinical utility of the 20% gait velocity improvement criterion for differentiating responders and non-responders in a cohort of patients with mostly probable iNPH, in whom clinical parameters alone were insufficient for classification. Notably, instrument-supported gait analysis validated this criterion by providing a more comprehensive characterization of gait disturbances compared to the 10 m walk test. However, further-especially longitudinal-studies are needed to reveal the full potential of the instrument-supported gait analysis in patients with (early/probable) iNPH.
特发性正常压力脑积水（iNPH）是认知障碍、尿失禁和步态障碍的一个潜在可逆病因，其典型表现为特征性的缓慢、拖曳且基底增宽的步态。与健康对照相比，iNPH患者的步态速度降低，在进行腰椎穿刺试验后步态速度会有所改善。本研究旨在评估在10米步行试验中步态速度提高20%这一标准，以识别接受腰椎穿刺试验的疑似iNPH患者队列中的反应者和无反应者，以及仪器辅助步态分析的附加价值。
我们对59例临床疑似iNPH且正在接受腰椎穿刺试验的患者进行了步速、节律、变异性、姿势控制和力量评估，采用了10米步行试验和仪器辅助步态分析。在10米步行试验中评估的步态速度变化用于区分对腰椎穿刺有阳性反应（改善>20%，反应者）和无相关反应（改善<20%，无反应者）的患者。使用卡方检验、独立样本t检验、曼-惠特尼-U检验和重复测量方差分析来分析组间差异。
与无反应者（n = 39）不同，反应者（n = 20）在10米步行试验的步态领域步速方面有显著变化。此外，仪器辅助步态分析显示仅反应者在步态领域变异性、节律、姿势控制和力量方面有额外改善。
本研究证实了在主要为疑似iNPH的患者队列中，20%步态速度改善标准在区分反应者和无反应者方面的临床实用性，在这些患者中仅临床参数不足以进行分类。值得注意的是，与10米步行试验相比，仪器辅助步态分析通过提供更全面的步态障碍特征验证了这一标准。然而，需要进一步的研究——尤其是纵向研究——来揭示仪器辅助步态分析在（早期/疑似）iNPH患者中的全部潜力。
